A New Blueprint for Care

Decades ago, breast cancer care was uniform. Now, thanks to IU’s Kathy Miller, Hari Nakshatri and a new generation of researchers redefining precision medicine, the future of treatment is as unique as every person it serves.

Matthew Harris Nov 26, 2025

EARLY IN KATHY MILLER’S career as an oncologist, the answers she gave to patients diagnosed with breast cancer were relatively straightforward. It was assumed that tissue was the same for every woman, and that a one-size-fits-all approach to treatment could thwart their disease.

“There was only one way of doing this,” said Miller, MD, the Ballvé Lantero Professor of Oncology at Indiana University School of Medicine. “It was the same for every patient, no matter where they went.”

Those days are gone. At the Vera Bradley Foundation Center for Breast Cancer Research, the future of prevention, detection, treatment and survivorship is being redesigned — one patient, one gene and one clinical trial at a time.

Over the past decade, advances in molecular profiling, a granular understanding of tumor biology and growing insights about the role of genetics have empowered oncologists to craft personalized treatments. That expanding body of knowledge is also helping basic science and clinical researchers better understand which patients are most likely to develop certain side effects so treatment might be altered to avoid toxicity.

“That helps us better individualize their therapy,” Miller said.

These paradigm shifts have also enabled IU Melvin and Bren Simon Comprehensive Cancer Center researchers to address long-standing disparities in care. For decades, it was taken as a given that normal breast tissue was the same across racial groups. “Turns out that it was absolutely not true,” Miller said.

It’s a shift from reactive treatment to proactive health management.

Kathy D. Miller, MD

Ballvé Lantero Professor of Oncology

Using tissue samples from IU’s Komen Tissue Bank, Hari Nakshatri, PhD, the Marian J. Morrison Professor of Breast Cancer Research, has demonstrated that normal breast tissue exhibits significant variations based on genetic ancestry. It helps explain why Black women are more likely to be diagnosed with aggressive subtypes like triple-negative breast cancer.

That insight helped Miller, a national leader in clinical trials, improve study designs that had resulted in an under-representation of women of color. Now, she structures some trials to evaluate how therapies perform in Black and non-Black women. “We’re doing the same clinical trial in both groups precisely so we don’t miss potential effectiveness,” she said.

Her decades-long partnership with Nakshatri has also transformed her thinking. “I ask different questions now,” Miller said. “And Hari is much more focused on what his research means for patients.”

It also reinforces the collaboration at the core of IU’s approach. Miller has also begun working closely with Pravin Kaumaya, PhD, the Vera Bradley Foundation Professor of Breast Cancer Innovation, an innovator in cancer vaccine development, on clinical trials testing a vaccine using peptides designed to help a patient’s immune system target HER-2 positive breast cancer.

“I couldn’t design and do innovative trials without someone like him,” she says. “And his peptides would stay in the lab without someone like me to bring them to patients.”

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Beyond treatment, IU researchers are trying to evolve prevention and survivorship strategies. Tarah Ballinger, MD, Vera Bradley Foundation Scholar in Breast Cancer Research, is investigating how exercise and muscle quality impact outcomes, while others are utilizing samples from the Komen Tissue Bank, the only research resource of its kind in the world, to test whether lifestyle interventions can biologically reduce cancer risk.

“It’s a shift from reactive treatment to proactive health management,” Miller said.

However, with new tools such as single-cell RNA sequencing and advanced bioinformatics, the challenge now is managing this complexity. “It’s like being dropped into a massive supermarket without a shopping list,” Miller said. The key, she believes, is asking the right questions — and doing so in partnership with scientists who understand both the lab and the clinic.

At IU, that partnership is thriving. And with it, a new era of breast cancer care is taking shape — one that’s more precise, more inclusive and more hopeful than ever before.

To support the Vera Bradley Foundation Center for Breast Cancer Research and help advance the future of breast cancer care, please contact Liz Standiford at estandi@iu.edu.

Tags: Cancer, Precision Health, Research Findings, Philanthropy